Home
Forms Library
Employee Claim - Workers' Compensation Board - NY.gov

Employee Claim - Workers' Compensation Board - NY.gov 2025

Employee Claim - Workers' Compensation Board - NY.gov Preview on Page 1

Show details

4.8 out of 5

60 votes

The document outlines the procedures for health insurers or health benefit plans to request reimbursement for health benefits paid on behalf of injured workers under New York State's Workers' Compensation system. It includes sections for submitting reimbursement requests, objections from workers' compensation carriers, and the process for arbitration if disputes arise. Detailed instructions are provided for all parties involved, emphasizing timelines and required documentation.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to edit Employee Claim - Workers' Compensation Board - NY.gov online

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

With DocHub, making changes to your documentation takes only a few simple clicks. Make these quick steps to edit the PDF Employee Claim - Workers' Compensation Board - NY.gov online for free:

Sign up and log in to your account. Log in to the editor with your credentials or click Create free account to evaluate the tool’s functionality.
Add the Employee Claim - Workers' Compensation Board - NY.gov for redacting. Click on the New Document option above, then drag and drop the sample to the upload area, import it from the cloud, or using a link.
Adjust your document. Make any changes required: add text and images to your Employee Claim - Workers' Compensation Board - NY.gov, highlight information that matters, remove sections of content and replace them with new ones, and add icons, checkmarks, and areas for filling out.
Finish redacting the template. Save the updated document on your device, export it to the cloud, print it right from the editor, or share it with all the people involved.

Our editor is very easy to use and effective. Give it a try now!

See more Employee Claim - Workers' Compensation Board - NY.gov versions

We've got more versions of the Employee Claim - Workers' Compensation Board - NY.gov form. Select the right Employee Claim - Workers' Compensation Board - NY.gov version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2018	4.8 Satisfied (60 Votes)
2009	4.4 Satisfied (179 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How can I eSign my [KEY] from Gmail?

With DocHub, it’s quite simple. The service offers users an add-on called DocHub for Gmail, which you can find in the Google Workspace Marketplace free of charge. Set it up and grant it access to your Google account. Open your email with your [KEY] attached and click on the add-on button in the right-side panel. Sign in to your DocHub account, and upload the file to our editor, where you can fill it out and sign.

How do you edit [KEY] online?

With DocHub, you have several convenient methods to edit your [KEY] online. You can drag and drop the form and modify it directly at the DocHub site or use our browser extension to fill out your form right away. Additionally, you can modify your PDF on your smartphone, as DocHub is compatible with all the available mobile platforms.

Who is eligible for workers compensation in New York?

Am I Entitled To Workers Compensation? Under New York State law, all employees who are injured in the course of work are entitled to receive workers compensation, regardless of what caused their injury.

How do I check the status of my workers compensation claim in NY?

If you filed a claim and were assigned a number, you can call (646)264-3000 for information about your claim. If you are a U.S. Department of Labor employee, please call (816)502-0301 for claim status information.

How long does it take to get a settlement from workers comp in NYS?

The entire settlement processfrom filing your claim to having the money in your handscan take around 12-18 months depending on the details of your case and whether or not you have legal representation.

Related forms

be ready to get more

Complete this form in 5 minutes or less

Get form

Which situation qualifies an employee for workers compensation coverage?

You must be an employee. Your employer must carry workers comp insurance. You must have a work-related injury or illness. You must meet your states deadlines for reporting the injury and filing a workers comp claim.

How long does it take to get a settlement from workers comp in NYS?

What is the phone number for NY State Workers Comp?

(877) 632-4996.

What does NYS workers comp pay?

Currently, the schedule is: Date of AccidentWeekly Maximum Total / PartialJuly 1, 2019 June 30, 2020$934.11 / $934.11July 1, 2018 June 30, 2019$904.74 / $904.74July 1, 2017 June 30, 2018$870.61 / $870.61July 1, 2016 June 30, 2017$864.32 / $864.3214 more rows

Can I get vacation pay while on workers compensation in New York?

Yes. Workers may receive sick or vacation time paid to them while they wait for their workers compensation case benefits to start.

Employee Claim - Workers' Compensation Board - NY.gov 2025

Here's how it works

How to edit Employee Claim - Workers' Compensation Board - NY.gov online

See more Employee Claim - Workers' Compensation Board - NY.gov versions

Complete this form in 5 minutes or less

Got questions?

How can I eSign my [KEY] from Gmail?

How do you edit [KEY] online?

Who is eligible for workers compensation in New York?

How do I check the status of my workers compensation claim in NY?

How long does it take to get a settlement from workers comp in NYS?

Complete this form in 5 minutes or less

People also ask

Which situation qualifies an employee for workers compensation coverage?

How long does it take to get a settlement from workers comp in NYS?

What is the phone number for NY State Workers Comp?

What does NYS workers comp pay?

Can I get vacation pay while on workers compensation in New York?

Related links

Try more PDF tools